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Sponsored by: |
University of Turin, Italy |
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Information provided by: | University of Turin, Italy |
ClinicalTrials.gov Identifier: | NCT00847158 |
This was a prospective, double-masked, 15-month clinical trial comparing efficacy of phacoemulsification alone to combined phacoemulsification and implantation of the iStent® trabecular micro-bypass stent in patients with primary open-angle glaucoma.
Condition | Intervention |
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Primary Open Angle Glaucoma and Cataracts |
Procedure: phacoemulsification alone Device: iStent Trabecular Micro-Bypass Stent |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Double Blind (Subject, Investigator), Dose Comparison, Parallel Assignment, Efficacy Study |
Official Title: | A Randomized, Double-Masked Clinical Trial of Phacoemulsification Compared With Phacoemulsification and Micro-Bypass Stent Implantation in Patients With POAG |
Enrollment: | 36 |
Study Start Date: | December 2006 |
Study Completion Date: | March 2008 |
Primary Completion Date: | March 2008 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
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1: Active Comparator
phacoemulsification alone
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Procedure: phacoemulsification alone
phacoemulsification alone
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2: Active Comparator
phacoemulsification and implantation of the iStent® trabecular micro-bypass stent
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Device: iStent Trabecular Micro-Bypass Stent
phacoemulsification and implantation of the iStent® trabecular micro-bypass stent
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This was a prospective, randomized open-label study of 36 patients with POAG scheduled to undergo phacoemulsification with intraocular lens implantation ("cataract surgery"). Patients were randomized 2:1 to receive either cataract surgery alone (control group) or cataract surgery and iStent implantation (combined surgery group).
Implantation of the study stent occurred after cataract extraction and IOL insertion using the same small, temporal, clear-corneal incision (approximately 3 mm) used to perform phacoemulsification and IOL placement. The study stent was guided into Schlemm's canal using ab-interno gonioscopy (using a Swan-Jacobs gonioscope). (Figure 1) If no complications occurred during phacoemulsification, acetylcholine was injected in the anterior chamber after the IOL implantation to constrict the pupil. The anterior chamber was then filled with a viscoelastic agent to reform the anterior chamber and provide more clearance in the angle.
The anterior chamber was traversed with the applicator (the implant was on the tip of applicator) and the trabecular meshwork located. The leading edge of the device was gently slid through the trabecular meshwork and into Schlemm's canal at the nasal position (3 to 4 o'clock for the right eye; 9 to 8 o'clock for the left eye) with the tip of the implant directed inferiorly. If difficulty was encountered with the insertion at the primary location, we tried inserting about 0.5 clock hour inferiorly; and continued to move inferiorly as needed for subsequent attempts. Next, the device was released by pushing the button on the applicator, position of the stent was verified and the applicator was withdrawn.
The patients were instructed to discontinue all glaucoma medications after surgery. Standard post cataract extraction antibiotic and anti-inflammatory drug regimen was prescribed. Target pressure for each patient was determined prior to study entry. Following the assigned procedure, any patient with an IOP (as measured between 8 and 10 AM) that was greater than 2 mm Hg over their target was instructed to return twice in the following three days for re-measurement of their IOP. If the patient's IOP was > 2 mm Hg over their target pressure, ocular hypotensive agents were added. The medications were added in a pre-set schedule, with beta-blockers first, angiotensin-converting enzyme (ACE) inhibitors second, and prostaglandins third. If, however, on the third consecutive visit the patient's IOP was within 2 mm Hg of target, patient re-entered the normal visit schedule. Investigators were masked to treatment assignment both when measuring IOP and when determining when or if to add medications.
Ages Eligible for Study: | 18 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Responsible Party: | University of Turin, Italy ( Antonio Fea ) |
Study ID Numbers: | iStent Washout study |
Study First Received: | February 18, 2009 |
Last Updated: | February 18, 2009 |
ClinicalTrials.gov Identifier: | NCT00847158 History of Changes |
Health Authority: | Italy: Ministry of Health |
POAG Combination glaucoma & cataract procedure trabecular micro-bypass stent iStent |
Glaucoma Eye Diseases Cataract Glaucoma, Open-Angle |
Lens Diseases Hypertension Ocular Hypertension |
Glaucoma Eye Diseases Cataract |
Glaucoma, Open-Angle Lens Diseases Ocular Hypertension |